Does Cholera Now Prevail?

black and white Illustration representing cholera
Cham. Illustration Representing Cholera. Digital Images, n.d. Open Wellcome Collection https://jstor.org/stable/community.24795874

By Catherine St. John

September 4, 1854

After 1849 I had hoped to never see Asiatic Cholera in London again. The hospitals have been filling up with cases since last year. There’s been a substantial outbreak that began in Saint James’s parish roughly five days ago, and many are already dead.[i]

St. James! Not St. Giles, where it killed in the epidemics before, but in the very parish in which Margret and I live.[ii] Not striking those base and putrid slums, but here.

black and white Illustration representing cholera
Illustration Representing Cholera.
Digital Images, n.d. Open Wellcome Collection https://jstor.org/stable/community.24795874

Madge always asked me after the outbreak of 1849 what I believed the cause of Cholera was. “There are so many theories,” she would say, “So what do you think, Henry?”

She is constantly asking me about my profession, and I usually attempt to answer to the best of my ability. About Cholera, however, I tell her I know three things: that the sun will rise in the morning, that we live by the grace of God, and that I am certain I have no clue what to think. She rolls her eyes. Madge then tells me I should’ve listened to my mother and stayed in York like my brother, because at least he doesn’t stink.

I tell her that she should have married him instead, and I am not sure if it is entirely a joke, and she laughs. It is a little conversation we rehearse. You run out of new things to talk about after ten years of being married, I suppose.

Many of my patients who are not on the Cholera ward ask me the same question. They are asking because they are afraid that they may get it. I must admit I have no answer for them. Many others do, or at least claim to; Farr’s report in the Register General about elevation was convincing,[iii] but one of my colleagues working in the area remains convinced it must be something in the water; it is an issue of the gut, he says, and therefore the causal agent must be consumed.[iv] Madge agrees with Snow. I am undecided. They all have their theories and their dogmas, but theories will not treat my patients.

I can only recommend temperance and restraint to my patients; though it is advice I doubt they shall follow. They are slovenly. They are often distrustful of me for one reason or another; my older colleagues have told me about all the dreadful business going on down in Liverpool during the outbreak of 1831.[v] I have some sympathy for the rioters twenty years ago – a proper burial should be allocated to everyone. However, the scientific advancement made by these dissections are forever ignored by the masses, and you can always get a proper burial after dissection. It appears paranoia and suspicion are things that always afflict the impoverished.

Today, I rose as always, had breakfast with Madge, and headed down to the hospital. The cholera ward is where I have been working since the outbreak, and I am mostly used to the smell. However, when you first arrive, the stench hits you like a fist and I always must hold back a gag. The beds were mostly full, except the conspicuously empty beds of those who died in the night. They will be filled by now.

Those in the beds are of all ages and both sexes. Ever since August, it has also been of the middle class; those who practice temperance.[vi] They line the walls and the orderlies can barely keep up with the demand for them. The sight is a wholly unpleasant one, the ward filled with moaning and sighing and the horrid stink of disease and death.

The past month has seen this ward expand and expand; hundreds of people have come in sick and dying, and we cannot see to help them. There must be dozens of patients in this ward, and my colleagues tell me there are roughly six hundred new cases a week.[vii] They’re all dying, and it seems more up to chance who survives than anything or my colleagues or I can do.

Today, a woman grabbed me when I inquired after her. She was pale, her skin blueish. Her hand was skeletal where it clutched my wrist.  Her grasp was weak, but I would not – could not – pull away. She appeared to be trying to say something to me, but she could not form the words. I could not begin to try to conjure up words of comfort. Her face was sunken in, and her jaw worked again, but she didn’t speak. The only noise that escaped her lips was a little gasp, and the hand fell from my wrist and off the small cot.

I gently placed it back on the cot and had to wrench myself away from the bed, off to the next patient with only a hand signal to one of the orderlies who would clear the body away.

When I got home, I carefully took off my hat, placing it on its hook. I gingerly took off my overcoat, and headed to the sitting room, where Madge was sitting.

“Any new observations today?” Madge asked me when I entered the room, after she greeted me.

I said nothing, merely collapsed in the chair next to hers. They are arranged the way she liked them, facing the fire, hers slightly closer.

She peered at me from over her book, curious, dark eyes searching for something.

“Madge,” I said, and stopped short, mouth still open.

After it became clear I was not continuing, she said, “Yes, Henry?” Her eyes were sharp, dissecting me.

I gritted my teeth and pressed my palms into my eyes. “I have no observations today. It’s the same thing, it’s always the same thing, and I can do nothing.”

There was silence, for a long time. I took my hands from my eyes, blinking to dispel the blur. I looked at her. Madge was taken aback. She reacted to my distress the way one reacts to a gift one doesn’t particularly want. The sympathy was a veil to cover her displeasure. She never did have a maternal touch. She opened her mouth, to console me, to upbraid me, I do not know.

I sigh. I cut to the end of our little play. “You should’ve married my brother.”

She did not laugh, merely hesitantly put her hand on mine. “Then I would’ve had to put up with his swollen head, and you know I couldn’t stand that, my dear.”

I gave a watery laugh. “I can do nothing, Madge.” I rested my head against the back of my chair. “They die and I seem to be incapable of helping in any way that matters.” Madge was silent, but she did not remove her hand.


[i] Howard Brody, Michael Russell Rip, Peter Vinten-Johansen, Nigel Paneth, and Stephen Rachman, “Map-Making and Myth-Making in Broad Street: The London Cholera Epidemic, 1854,” The Lancet (British edition) 356, 9223 (2000): 65.

[ii] Pamela K. Gilbert, Mapping the Victorian Social Body, (Albany: State University of New York Press, 2004), 91, 95.

[iii] Tessa Cicak, and Nicola Tynan, “Mapping London’s Water Companies and Cholera Deaths,” London Journal 40, 1 (2015): 25.

[iv] Brody, “Map-Making and Myth-Making in Broad Street: The London Cholera Epidemic, 1854,” 64.

[v] Sean Burrell and Geoffrey Gill, “The Liverpool Cholera Epidemic of 1982 and Anatomical Dissection – Medical Mistrust and Civil Unrest,” Journal of the History of Medicine and Allied Sciences 60, 4 (2005): 485.

[vi] Gilbert, Mapping the Victorian Social Body, 98.

[vii] Nigel Paneth, Peter Vinten-Johansen, Howard Brody, and Michael Rip, “A Rivalry of Foulness: Official and Unofficial Investigations of the London Cholera Epidemic of 1854,” American Journal of Public Health 88, 10 (1998): 1546.